Senior NHS managers, many of whom are living with the threat of suspension because their face no longer fits, need a formal procedure for when things go wrong.

That is the view of their union, the First Division Association, which says the number of 'gardening leave' cases has grown substantially.

It wants to see a formal national disputes resolution procedure, rather than the inappropriate long-term suspension of staff.

The association has 800 NHS members. Last year there were 12 cases in which senior managers were suspended. Four were chief executives. Two cases are ongoing.

Of the 10 others, one person returned to work, another two resigned and seven left with compensation.

The association is aware of six other members who face similar situations, but because they joined the association after the problem began, it is not representing them. The association's NHS senior negotiator Jon Restell said: 'We've got one case where it is quite clear that the chief executive is not the issue. Part of the board want to get the chair out and the only way is to remove the chief executive first.'

Most chief executive contracts would spell out the terms of any termination, but the association wants to see a formal, independent process introduced for senior managers who find themselves in this situation.

'It is never resolved, you just leave with a package, ' says Mr Restell. 'It costs the NHS a lot of money, but these people shouldn't be leaving in the first place.'

The FDA says managers are more likely to be quietly offered enough for them to clear their desk - sometimes beyond the minimum required by their contract.

Les Howell, who was chief executive at Guild Community Health Care trust in Preston, Lancashire, threatened to go to industrial tribunal after he alleged he was forced out of the trust by a new chair. Mr Howell was then offered 18 months' pay -£96,000 - which would take him to the end of his contract.

'There has been no dismissal, no appeal, ' he says. 'Staff there even now don't know why I've gone.'

At the time the trust said it had 'no alternative but to terminate his employment' but did not say why.

Hilary Rowland, chief executive at Alder Hey Hospital, Liverpool, which is at the centre of an Department of Health organ retention inquiry, went on leave in March for what the trust described as a 'well-deserved rest'.

Nothing has been said since.

Liverpool Eastern community health council chief officer Wendy Natale said there was 'clearly a lack of honesty' in the way the case was handled.

'Everyone knew why she was being removed but there was no further comment.' A spokeswoman for Alder Hey said that it could make no comment until after the DoH report was published.

Hugh Taylor, NHS Executive director of human resources, told a conference on employment relations last week: 'We will take the association's concerns on board and consider the specific proposals they put forward.'